| NPI | 1013318757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 340214) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 769961) |
| Enumeration Date | 2014-09-12 |
| Last Update Date | 2019-02-04 |